Provider Demographics
NPI:1053721290
Name:POLZIN, ANITA B (LPC)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:B
Last Name:POLZIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:B
Other - Last Name:MERSHON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1601 OLD SOUTH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4120
Mailing Address - Country:US
Mailing Address - Phone:636-246-1210
Mailing Address - Fax:636-246-1008
Practice Address - Street 1:4066 DUNNICA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-3510
Practice Address - Country:US
Practice Address - Phone:636-224-1700
Practice Address - Fax:314-535-5917
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5961101YP2500X
MO2022022871101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746170GMedicaid